Lipid Cascade With Reflex to Lipoprotein Particle Assessment by NMR (Without Graph)

The lipid cascade supports risk assessment and management of patients who present with cardiometabolic risk (CMR) factors (e.g., elevated blood pressure, abdominal obesity, insulin resistance (IR), lipoprotein abnormalities and elevated blood glucose).

Conventional lipid profile results are indirect estimates of the actual lipoproteins that transport cholesterol, many of which may be atherogenic. Additionally, basic lipid profile results do not: (1) account for the variability in cholesterol subfraction content; (2) measure lipoprotein particle size and number; or (3) provide information suggestive of changes associated with IR progression.

In patients with an LDL cholesterol result <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR to evaluate LDL particle number (additional charge on reflex). This reflex is derived from the Multi-Ethnic Study of Atherosclerosis (MESA), a medical research study involving more than 6,000 men and women from six communities in the United States and sponsored by the National Heart Lung and Blood Institute of the National Institutes of Health.¹ In this study, it was found that where the LDL cholesterol (LDL-C) and LDL particle number (LDL-P) are discordant (i.e., LDL/C "normal," but the LDL-P is elevated), CVD risk always follows the LDL-P. This means the patient with high LDL-P but "normal" LDL-C is really at high risk for future cardiovascular events. The reflex is therefore designed to look for residual CVD risk in patients where cholesterol does not tell the whole story. The lipid cascade provides a lipoprotein IR score as a qualitative indicator of the patient's insulin resistance and risk for diabetes. In patients with a triglyceride result >800 mg/dL, the lipid cascade automatically reflexes to a direct LDL (additional charge on reflex). If the direct LDL result is <130 mg/dL, the lipid cascade automatically reflexes to lipoprotein analysis by NMR.